Here is a recent case we had of a man who was mugged while walking to work. His work-up revealed Le Fort type 2 fracture and subarachnoid/subdural hematomata.
Let's review the types of Le Fore fractures
Le Fort I fracture (horizontal)- Force of
injury directed low on the maxillary alveolar rim in a downward direction. The
fracture extends from the nasal septum to the lateral pyriform rims, travels
horizontally above the teeth apices, crosses below the zygomaticomaxillary
junction, and traverses the pterygomaxillary junction to interrupt the
pterygoid plates
Le Fort II fracture (pyramidal)- Blow to the lower or mid maxilla. Fracture has a pyramidal shape
and extends from the nasal bridge at or below the nasofrontal suture through
the frontal processes of the maxilla, inferolaterally through the lacrimal
bones and inferior orbital floor and rim through or near the inferior orbital
foramen, and inferiorly through the anterior wall of the maxillary sinus; it
then travels under the zygoma, across the pterygomaxillary fissure, and through
the pterygoid plates.
Le Fort III fractures (transverse)- Follow impact to the nasal bridge or upper maxilla. Fractures
start at the nasofrontal and frontomaxillary sutures and extend posteriorly
along the medial wall of the orbit through the nasolacrimal groove and ethmoid
bones. The fracture continues along the floor of the orbit along the inferior
orbital fissure and continues superolaterally through the lateral orbital wall,
through the zygomaticofrontal junction and the zygomatic arch. Intranasally, a
branch of the fracture extends through the base of the perpendicular plate of
the ethmoid, through the vomer, and through the interface of the pterygoid
plates to the base of the sphenoid
Antibiotics-
Yes
If the original fracture sites were open to the
external environment or in communication with intraoral or intranasal spaces,
implement prophylactic antibiotics covering gram-positive and anaerobic
organisms for 5-10 days.
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